Primary Health Care Management Effectiveness as a Driver of Family Planning Service Readiness: A Cross-Sectional Analysis in Central Mozambique

Stephen Pope; Orvalho Augusto; Quinhas Fernandes; Sarah Gimbel; Isaías Ramiro; Dorlim Uetela; Stélio Tembe; Meredith Kimball; Mélia Manaca; C. Leigh Anderson; Sérgio Chicumbe; Kenneth Sherr

doi:10.9745/GHSP-D-21-00706

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FIGURE
Distribution of Integrated District Evidence-to-Action Strategy Health Facilities in Central Mozambique (N=72)

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TABLE 1.

Characteristics of Health Facilities and Facility Managers Analyzed, Central Mozambique

		Median (IQR)
Health facilities (N=68), mean (SD)
Number of total staff	30.2 (38.4)	9.0 (4.0, 51.5)
Number of clinical staff	20.7 (26.2)	5.0 (3.0, 34.3)
Number of pharmacy staff	2.1 (2.8)	1.0 (0.0, 4.0)
Number of laboratory staff	2.0 (3.7)	0.0 (0.0, 3.0)
Number of administrative staff	5.3 (10.7)	1.0 (0.0, 3.3)
Distance to provincial health directorate in km	125.4 (109.9)	104.0 (29.75, 187.5)
Rural facilities, No. (%)	54 (79.4)
Rural health center Type I	9 (13.2)
Rural health center Type II	42 (61.8)
Health center adjoining secondary-level hospital	3 (4.4)
Urban facilities, No. (%)	14 (20.1)
Urban health center type A	4 (5.9)
Urban health center type B	8 (11.8)
Urban health center type C	2 (2.9)
Facility managers (N=68)
Years of experience in the health sector	8.4 (8.4)	5.0 (3.0, 8.7)
Years of experience as a facility manager	2.5 (2.1)	2.0 (1.0, 3.0)
First-time health facility managers, No. (%)	47 (69.1)
Received formal management training	18 (26.5)

Abbreviations: IQR, interquartile range; SD, standard deviation.

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TABLE 2.

Management Effectiveness Scores Among Study Facilities^a Central Mozambique, (N=68)

	Mean (SD)
Overall management effectiveness score	0.59 (0.17)
Management practices domain score	0.63 (0.18)
Proportion of time managers spent on managerial duties	0.63 (0.16)
Facility keeps records of staff absences	0.90 (0.31)
Facility conducted performance reviews with employees in past 12 months	0.63 (0.49)
Facility linked work performance to employee salaries and incentives	0.12 (0.33)
Facility requested medication once per month in the past 12 months	0.88 (0.33)
External supervision domain score	0.54 (0.29)
Facility received 6 external supervisory/technical visits in past 6 months^b	0.65 (0.42)
External supervisor used a control or verification list during most recent visit	0.66 (0.48)
External supervisor observed consultations during most recent visit	0.59 (0.50)
External supervisor observed staff attendance logs during most recent visit	0.53 (0.50)
External supervisor observed stocks of medications during most recent visit	0.72 (0.45)
External supervisor observed financial registries during most recent visit	0.31 (0.47)
Facility staff received an evaluation summary from external supervisor during most recent visit	0.30 (0.43)
Community engagement domain score	0.59 (0.27)
Facility community health committee met monthly during the past 12 months^c	0.42 (0.38)
Facility collects patient opinions through a formal mechanism	0.75 (0.39)
Facility made management changes based on patient opinions in past 6 months	0.62 (0.49)

↵a Overall management effectiveness domain scores are averages of individual component indicators on a scale of 0 (lowest) to 1 (highest). All individual component indicators are binary from 0 (No) to 1 (Yes) unless otherwise specified.
↵b Fewer than 3 visits (0); 3 or 4 visits (0.5); 5 or more visits (1).
↵c Fewer than 3 meetings (0); 3 to 5 meetings (0.25); 6 to 11 meetings (0.5); 12 or more meetings (1).

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TABLE 3.

Family Planning Readiness Domain Scores Among Study Facilities (N=68), Central Mozambique

	Mean (SD)
Overall family planning readiness score^a	0.69 (0.20)
Provision and prescription readiness domain score	0.64 (0.12)
Facility provides or prescribes any of the following modern methods of family planning:
Combined estrogen progesterone oral contraceptive pills	0.94 (0.24)
Progestin-only contraceptive pills	0.90 (0.31)
Combined estrogen progesterone injectable contraceptives	0.35 (0.48)
Progestin-only injectable contraceptives	0.72 (0.45)
Male condoms	0.87 (0.34)
Female condoms	0.57 (0.50)
Intrauterine contraceptive device	0.97 (0.17)
Implants	0.97 (0.17)
Emergency contraceptive pills	0.71 (0.46)
Male sterilization	0.00 (0.00)
Female sterilization	0.04 (0.21)
Guidelines and checklists readiness domain score	0.74 (0.38)
Facility has the following documents available at time of survey:
National family planning guidelines	0.66 (0.48)
Family planning checklists and/or job aids	0.81 (0.40)
Trained staff readiness domain score	0.72 (0.45)
Facility family planning staff members received any family planning training in the last 2 years	0.72 (0.45)
Current stock readiness domain score	0.71 (0.17)
Facility has the following reproductive health medicines and commodities available at the time of survey^b:
Combined estrogen progesterone oral contraceptive pills	0.82 (0.38)
Progestin-only contraceptive pills	0.77 (0.42)
Combined estrogen progesterone injectable contraceptives	0.27 (0.45)
Progestin-only injectable contraceptives	0.71 (0.46)
Male condoms	0.72 (0.45)
Female condoms	0.46 (0.50)
Implants	0.94 (0.24)
Emergency contraceptive pills	0.68 (0.47)
Intrauterine contraceptive device	0.93 (0.26)
Stock-out readiness domain score	0.69 (0.30)
Facility had a stock-out in the past 3 months for each of the following^c:
Female condoms	0.50 (0.50)
Implants	0.90 (0.30)
Emergency contraceptive pills	0.67 (0.47)

↵a Overall family planning readiness and domain scores are averages of individual component indicators on a scale of 0 (lowest) to 1 (highest). All individual component indicators are binary from 0 (No) to 1 (Yes) unless otherwise specified.
↵b Never available or not available today (0); reported available but not seen (0.33); available but not valid (0.66); at least 1 available and valid (1).
↵c Facility stock-out register is not available, or the facility had a stock-out of any length of time during the previous 3 months, or the product is not provided or prescribed, or facility stock-out register is not filled in (0); facility has not had any stock-outs during the previous 3 months (1).

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TABLE 4.

Logistic Quantile Regression Model Estimates for Overall Family Planning Readiness, Central Mozambique

	Model A^a		Model B^b		Model C^c
Variable	OR (95% CI)	P value	OR (95% CI)	P value	OR (95% CI)	P value
Overall management score	7.15 (3.02, 16.91)^d	<.001^d	4.70 (1.95, 11.30)^d	<.001^d	4.88 (1.86, 12.82)^d	.001
Facility type
Rural health center	-		reference		reference
Urban health center	-		2.29 (0.65, 8.04)	.198	2.10 (0.49, 8.96)	.32
Adjoining hospital	-		4.09 (0.12, 138.12)	.432	4.26 (0.15, 123.40)	.40
Distance to DPS in 10 km	-		-		0.99 (0.95, 1.04)	.79
Years’ experience as manager	1.30 (1.03, 1.63)^d	.025^d	1.20 (1.02, 1.43)^d	.0317^d	1.21 (1.01, 1.45)^d	.042^d
Facility type
Rural health center	-		reference		reference
Urban health center	-		5.23 (1.18, 23.06)^d	.029^d	5.12 (0.98, 26.66)	.05
Adjoining hospital	-		4.38 (0.28, 67.42)	.289	4.42 (0.28, 70.88)	.29
Distance to DPS in 10 km	-		-		1.00 (0.93, 1.07)	.96
First-time facility manager	3.20 (1.21, 8.48)^d	.019^d	2.12 (0.93, 4.82)	.073	2.12 (0.89, 5.01)	.09
Facility type
Rural health center	-		reference		reference
Urban health center	-		3.82 (0.84, 17.39)	.083	3.84 (0.71, 20.79)	.12
Adjoining hospital	-		6.11 (0.08, 466.80)	.413	6.10 (0.08, 481.45)	.42
Distance to DPS in 10 km	-		-		1.00 (0.94, 1.06)	.99

Abbreviations: CI, confidence interval; DPS, provincial health directorate; OR, odds ratio.
↵a Unadjusted.
↵b Adjusted for facility type (rural center, urban center, center adjoining hospital).
↵c Adjusted for facility type (as above) and distance to DPS.
↵d Indicates statistical significance at P<.05.